no weight loss connected to hypothyroidism and SSRIs?

Question
For the last 6 weeks I have been exercising at the gym 5 days a week(cardio and weight training) for 1 hour a day under the guidance of a personal trainer, supposedly burning 400 calories, and I'm eating about 1500 calories daily. In 6 weeks I haven't lost any weight whatsoever and my body fat percentage has actually INCREASED from 30% to 32%. I take 50mg levothyroxine daily for hypothyroidism and 20mg paroxetine for anxiety. I also get bad fluid retention. Nutritionally, I'm practically vegan, avoiding dairy, eggs, meat and fish but I will eat some shellfish like mussels(about 3 times a week). I eat plenty of fruit, veggies, grains, pulses, nuts and seeds, plus the shellfish, and have no junk food at all in my diet. I take a multivitamin and calcium supplement daily, and kelp supplement about 3 times a week. I don't eat soya as I've heard it can interfere with the thyroid, so why can't I lose even 1kg of weight?
Thank you very much in advance Bret.

Answer
Hello Susanah,
Thank you for your question.  It has taken me a bit to write this response, but I felt that the time was necessary as you are doing so many things right and not seeing the weight loss results you desire.  

I first want to commend you on your dedication.  Getting to the gym 5 days a week is great!  Please don't give that up, as it is an important component of weight loss.  

Nutritionally, you are eating quite well.  Your food choices sound excellent, and a Vegan approach has consistently shown to produce weight loss, especially when the foundations are fruits, vegetables, and grains, as you are doing.  The only thing that might be playing a role is the total number of calories.  You may want to reduce your calories slightly and see if that initiates weight loss.  I would not recommend going below 1,200 per day as nutritional deficiencies may begin to emerge.

The Levothyroxine does not cause weight gain or stop weight loss, but you might want to look more closely at the dosage, as you may not be supplying the body with enough replacement hormone, and this could be the cause of your difficulty losing weight.  Talk to your doctor about a trial of a higher dosage.  You will know quite quickly if it is working.  Finding the optimal thyroid replacement dosage is as much an art as it is a science.  

Complementary physicians usually prefer to monitor a patient抯 basal body temperature and the clinical symptoms as the main guideposts to the optimal dosage.   It may take several weeks before the benefits are realized and the basal body temperature returns to normal.
By contrast, most mainstream physicians guide the dosage level of Synthroid and similar drugs by the conventional blood levels of TSH and sometimes T4. As the body receives external T4, the pituitary feedback mechanism will sense the increased level of circulating T4 and reduce the output of thyroid stimulating hormone. It presumes the thyroid requires less direction to increase its production of the hormone.

You may also want to try a different medication.  When a therapeutic trial of thyroid hormone is indicated, physicians and their patients can choose from a number of medications that are available by prescription. These pharmaceuticals may be natural or synthetic in origin, but the fundamental difference lies in the types of thyroid hormones they contain.

The most commonly prescribed thyroid medication is Synthroid, which contains T4 only.   Many complementary or alternative physicians prefer a natural prescription product called Armour Desiccated Thyroid Hormone because it contains both T3 and T4, reflecting the human thyroid抯 production of both hormones. This medication is derived from the thyroid gland of a pig and closely resembles the human thyroid gland output. It is dried or desiccated and processed into tablets. People who take desiccated animal thyroid may also receive intermediary substances such as T1 and T2 thyroid hormones; some patients seem to need these substances, while others do not.

Two other natural thyroid prescription options are Westhroid and Nature-Throid, both produced by Western Research Laboratories. These products contain all four hormones that occur naturally in the thyroid gland桾3 and T4, as well as T1 and T2. By supplying T3, Westhroid and Nature-Throid ensure that this hormone can be put directly to work, rather than assuming the T4-to-T3 conversion will occur at the tissue level.

Another pharmaceutical option for patients is Thyrolar (Liotrix Tablets, UPS), a thyroid product that also contains both T4 and T3 hormones. Rather than being derived from animals, this medication is a synthetically prepared mixture of liothyronine sodium (T3) and levothyroxine sodium (T4). The T3-to-T4 ratio in Thyrolar dosages is 1:4. In a one-half grain dose, for example, Thyrolar contains 6.25 mcg of T3 and 25 mcg of T4.  So your current medication is one of many options and you may need to try a few to find the one that works best in your body.

You mentioned soy and thyroid.  Yes, soy has been shown to interfere with thyroid function in some people, and our research is not yet conclusive on the interactions of soy and the human thyroid, so your avoidance of it is warranted.

I do have one more possibility for you to consider.  Food may delay or reduce the absorption of many drugs, including thyroid hormone. Food can often slow the process of the stomach entering, but it may also affect absorption of the drug you're taking by binding with it, by decreasing access to absorption sites, by altering the rate at which it dissolves, or by changing the stomach's pH balance. This is why many doctors recommend that for best absorption of your thyroid hormone, you should take it first thing the morning, on an empty stomach, one hour before eating.

However, if you cannot take it this way, consistency becomes the key. If you're going to take your thyroid hormone with food, take it every day with food, consistently. If you've changed from taking it on an empty stomach, then around six to eight weeks after you start taking it with food, you should have another blood test to ensure you're receiving the proper amount of thyroid hormone. Taking the drug with food might inhibit absorption somewhat, but this safety check will make sure your dosage gets tweaked if it needs to be changed slightly. Don't take it some days with food, some days without, or you're sure to have erratic absorption, and it will be harder to regulate your levels.

Please, please, please feel free to e-mail me back with any specifics, or if I can elaborate or clarify anything.  I know that this was quite in-depth, but I have found that when dealing with thyroid function that it takes this level of analysis to create the optimal dosage and combination for each individual person.  

Best of health,
Dr. Bret
Doctoremery.com  

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